Your report on Alan Milburn's views on the health reforms (29 March) exaggerates the extent of his opposition to, and underplays the degree to which he challenges, Labour's position. Milburn argues that competition among providers will be good for patients. This is core to the reforms and a position that some in the Labour party find hard to accept as they have taken a strong anti-market position – not because of a carefully reasoned analysis, but because it plays well with key interest groups. If Labour aligns itself with providers, not patients, it will make it hard for them to oppose the reforms in an intelligent way.
There are undoubtedly grounds to criticise the reforms, and Milburn is right to say there is a risk of confusion. The secretary of state does seem to be in denial about the short-term costs of reform and, as a consequence, unwilling to prepare the Conservatives to face these. It's clear that if we are to secure a more affordable NHS, where investment follows the needs of patients, then hospital reconfigurations, and even some closures, are inevitable. We cannot spend more on prevention and primary care if hospitals keep their share of the budget. There are plenty of details in the reform plan that deserve criticism but Labour (and the Lib Dems) will miss the mark if their opposition is based on rhetoric, not proper analysis.
Dr Stephen Black
PA Consulting Group
Dr Stephen Black is a health management expert at PA Consulting Group.
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